The International journal on drug policy
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Int. J. Drug Policy · May 2009
Theorizing "Big Events" as a potential risk environment for drug use, drug-related harm and HIV epidemic outbreaks.
Political-economic transitions in the Soviet Union, Indonesia, and China, but not the Philippines, were followed by HIV epidemics among drug users. Wars also may sometimes increase HIV risk. Based on similarities in some of the causal pathways through which wars and transitions can affect HIV risk, we use the term "Big Events" to include both. ⋯ These variables that Big Events affect may include population displacement; economic difficulties and policies; police corruption, repressiveness, and failure to preserve order; health services; migration; social movements; gender roles; and inter-communal violence--which, in turn, affect normative regulation, youth alienation, networks and behaviours. As part of these pathways, autonomous action by neighbourhood residents, teenagers, drug users and sex workers to maintain their economic welfare, health or happiness may affect many of these variables or otherwise mediate whether HIV epidemics follow transitions. We thus posit that research on whether and how these interacting causal pathways and autonomous actions are followed by drug-related harm and/or HIV or other epidemics can help us understand how to intervene to prevent or mitigate such harms.
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Int. J. Drug Policy · Mar 2009
Pain, physical dependence and pseudoaddiction: redefining addiction for 'nice' people?
The undertreatment of pain has increasingly been framed as both a public health problem and a human rights issue. The application of rights-based discourses to the field of pain management has provided an important means of critiquing "opiophobia" amongst healthcare professionals and challenging current criminal-legal and regulatory sanctions on the distribution of opiate medications. This movement would therefore appear to align with harm reduction advocacy and longstanding criticisms of international drug policies. However, discourses on pain management rest on moral as well as medical assumptions about who has pain and who needs drugs. ⋯ Present efforts to secure access to pain relief as a human right are likely to undermine, rather than advance, the rights of so-called 'drug addicts'.
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Int. J. Drug Policy · Mar 2009
Evaluation of the Staying Alive programme: training injection drug users to properly administer naloxone and save lives.
In response to the high rates of opiate-related overdoses and deaths in the United States, a number of overdose prevention programmes have been implemented that include training drug users to administer naloxone, an opiate antagonist. The purpose of this study was to evaluate the Staying Alive (SA) programme in Baltimore, Maryland, which trained drug users to prevent and respond to opiate overdose using techniques including mouth-to-mouth resuscitation and administration of naloxone. ⋯ Results from this study provide additional evidence to support the effectiveness of overdose prevention training programmes that include skills building for drug users to administer naloxone.
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Int. J. Drug Policy · Mar 2009
Qualitative evaluation of a peer-based needle syringe programme in Vietnam.
Harm reduction has been identified as an important HIV prevention strategy for injecting drug users (IDUs) in Vietnam. However, to date only small geographically limited formal needle syringe programmes (NSPs) have been implemented; and little attention has been given to assessing the effectiveness of the piloted models. Using data from a qualitative evaluation of an NSP in northern Vietnam, this paper assesses the effectiveness of the intervention, examines barriers to the NSP, and documents lessons which can be applied to replicate and scale up interventions across Vietnam. ⋯ Programme success is dependent upon community support. Resistance to NSPs can be overcome through a programme of intensive advocacy with community stakeholders including; local government, mass organizations, local residents, IDUs and their families. Garnering the support of law enforcement officials requires a sustained effort.
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Policy decisions are informed by a number of factors: politics, ideology and values, perceived public opinion, and pragmatic constraints such as funding. Research evidence is also used to inform decision-making but must compete with these other inputs. Understanding how policy makers access research evidence may assist in encouraging greater use of this evidence. This study examined the sources of research evidence that Australian government drug policy makers accessed when faced with their most recent decision-making opportunity. ⋯ There is a tension between the type of information source most suited to policy makers--simple, single-message, summative and accessible--and the types of information produced and valued by researchers--largely academic publications that are nuanced and complex. Researchers need to consider the sources that policy makers use if they wish their research to be utilised as one part of policy making.